case files ob/gyn

Question 1

what should you tell a pt close to due date about normal reasons to come to the hospital

Answer 1

-Feel a gush of fluid -painful regular contractions

Question 2

what should you tell a pregnant pt about abnormal signs that should prompt immediate visit

Answer 2

-vaginal bleeding -dec fetal movement -preeclampsia symptoms: headache, visual changes, puffy face, epigastric/RUQ pain

Question 3

Calculate EDD for LMP of July 4, 2016

Answer 3

April 11, 2017

Question 4

phases of labor

Answer 4

Latent phase

• onse of contractions to 6 cm dilated
• variable in length: nulliparous-20 hr, multiparous-14 hr
• cervical effacement>cervical dilation

Active phase

-6 cm dilated to 10 cm max dilation

Question 5

def of arrested active labor

Answer 5

active labor: woman is >6 cm and ROM and not progressing despite

-adequate contractions for 4 hours

OR

-inadequate contractions for 6 hours

Question 6

what are the 3 P’s of labor?

Answer 6

power: uterine contractions

• resting tone of uterus
• duration of contractions
• strength of contractions: measured by intrauterine catheter

pelvis: is the pelvis abnormal

passenger-fetal size and presentation

lie: longitudinal or transverse
attitude: flexed

presentation; cephalic or breech

fetal head size and shoulder size for dystocia

position:

Question 7

def of adequate labor

Answer 7

contractions every 2-3 minutes, uterus firm on palpation, lasting btwn 40-60 sec

Question 8

how do you evaluate adequate uterine contractions

Answer 8

Question 9

what are the types of htn in pregnancy

Answer 9

Question 10

chronic htn in pregnancy

• timeline
• RX

Answer 10

Timeline: >140/90 before 20 wks for any reason. Re-check in 2 weeks.

-check US for IUGR, UA for proteinuria

RX

• (#1) a-methyldopa
• hydralazine

labetalol

nifedipine

Question 11

gestational htn

Answer 11

Elevated BP after 20 weeks in the absence of proteinuria or the other systemic findings of preeclampsia.

Question 12

which test do you use to test or maternofetal hemorrhage

Answer 12

Kleihauer–Betke test

The Kleihauer–Betke (“KB”) test, Kleihauer–Betke (“KB”) stain, Kleihauer test or Acid elution test, is a blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream

-fetal Hb is resistent to acid but adult Hb is removed by acid

Question 13

for a pt with placental abruption with…which is the best mode of delivery

• live fetus
• fetal demise

Answer 13

live fetus-c section or vag

fetal demise-vaginal birth

Question 14

which type of vaginal bleeding is assoc with DIC

Answer 14

placental abruption

• dec fibrinogen
• inc PT, PTT

Question 15

1 liner for placental abruption

Answer 15

painful 3rd trimester vag bleeding, abdominal pain, normal placenta, DIC, htn/preeclampsia, cocaine/smoking

Question 16

patient in labor has polyhydramnios and vaginal bleeding. What’s the likely cause

Answer 16

Placental abruption

-polyhydramnios can cause inc uterine cavity compression leading to placental abruption

Answer 17

placental abruption-

Question 18

Vaginal bleeding+hard mass that bleeds

Answer 18

cervical cancer

Question 19

3rd trimester vaginal bleeding+soft cervical lesion

Answer 19

cervical polyps

Question 20

risk factors for shoulder dystocia

Answer 20

previous hx of shoulder dystocia

macrosomia

maternal diabetes

prolonged 2nd stage of labor

excesive weight gain >35 lb in pregnancy

Question 21

what is the order of maneuvers that should be done during a shoulder dystocia

Answer 21

1. McRoberts manuever+suprapubic pressure

-hyperflex the maternal thighs against the abdomen to rotate the pubic symphysis towarard the maternal head+push the fetal fetal shoulders into an oblique plane

2, Wood’s corkscrew maneuver-rotate the posterior shoulder in a 180 degree corkscrew fashion

3. Delivery of the posterior arm
4. Zavanelli maneuver-push the head back in (cephalic replacement) followed by c-section

Question 22

fetal complications of shoulder dystocia

Answer 22

-brachial plexus injury-1% permanent damage, majority correct within 8 months

-clavicular fracture

-hypoxic-ischemic encephalopathy

-death

-

Question 23

maternal complications from shoulder dystocia

Answer 23

peroneal/cervical lacerations->postpartum hemorrhage

bruising

tearing

Question 24

fetal sign of shoulder dystocia

Answer 24

fetal head retracts back toward the maternal introitus=TURTLE SIGN

Question 25

what is a drussen incision

Answer 25

cutting through the cervix to relieve an entrapped fetal head of a breech delivery

Question 26

post menopausal pt presents with a cervical lesion. which test do you perform next

-pap smear, colposcopy, or biopsy

Answer 26

Biopsy-diagnostic test for cervical cancer

• don’t do a pap smear bc that is a screening test that doesn’t rule out cervical cancer. We already know she has a cervical lesion
• colposcopy is a visual inspection to reveal cervical lesions. She already has an obvious cervical lesion so you don’t need a colposcopy

Question 27

which diseases do ashkenazi jews have higher incidences of

Answer 27

autosomal recessive diseases

lysosomal storage diseases: tay sachs, niemann pick

familial dysautonomia

fanconi anemia

Canavan syndrome

Bloom syndrome

cystic fibrosis

(not thalassemias)

Question 28

mom-black, no fam hx of sickle cell

dad-black, brother has sickle cell

what is the risk of their baby having sickle cell anemia

-carrier rate of sickle cell in black population

Answer 28

baby’s likelihood of developing sickle cell

(mom carrier) x (dad carrier) x (likelihood of 2 AR parent carriers having kid w/ sickle cell)

1/10 x 2/3 x 1/4=1/60